title: Primary and secondary care consultations in elderly demented individuals in France. Results from the Three-City Study.
abstract: OBJECTIVE
  Our purpose was to analyze consultations with primary- and secondary-care physicians by demented people and identify factors that hamper or facilitate consultation.
  
  
  METHODS
  In total, 498 demented subjects were evaluated within the Three-City Study, a population-based cohort of individuals aged >or=65 years.Primary- and secondary-care consultations (consultation with a specialist and/or treatment with anti-dementia drugs) were assessed by a neurologist or geriatrician.
  
  
  RESULTS
  Thirty-five percent of the demented subjects did not seek advice for their cognitive problems and only 31% consulted a specialist. Consultation for primary care was principally dependent on the subjects' own awareness of the cognitive disorder and on their age. Factors associated with consultation for secondary care were younger age, higher education level, higher instrumental activities of daily living disability and awareness of the cognitive disorder by the subject, all of which predicted more frequent consultation. The level of cognitive performance had only a slight influence on primary care and none on secondary care.
  
  
  CONCLUSIONS
  The failure to see a physician due to dementia, especially secondary-care practitioners, is frequent in the community, particularly in the oldest subjects.
authors.affiliation: INSERM, U897, Université Victor-Segalen Bordeaux-2, Bordeaux, France. Catherine.Helmer@isped.u-bordeaux2.fr
authors.forename: Catherine
authors.initials: C
authors.lastname: Helmer
authors.forename: Karine
authors.initials: K
authors.lastname: Pérès
authors.forename: Antoine
authors.initials: A
authors.lastname: Pariente
authors.forename: Florence
authors.initials: F
authors.lastname: Pasquier
authors.forename: Sophie
authors.initials: S
authors.lastname: Auriacombe
authors.forename: Michel
authors.initials: M
authors.lastname: Poncet
authors.forename: Florence
authors.initials: F
authors.lastname: Portet
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouaud
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
authors.forename: Christophe
authors.initials: C
authors.lastname: Tzourio
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
mesh_terms: D000368:Aged / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004493:Education; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors